Involutional ectropion
Introduction
Involutional (age-related) ectropion affects the lower lid of elderly patients. It causes epiphora (tear overflow) and should exacerbate ocular surface disease. The red appearance of the exposed conjunctiva is cosmetically poor. In long-standing cases the tarsal conjunctiva may become chronically inflamed, thickened and keratinized.
Aetiological factorsinclude:
• Horizontal lid laxity are often demonstrated by pulling thecentral a part of the lid 8 mm or more from the world , with afailure to snap back to its normal position on releasewithout the patient first blinking. Lateral canthal tendon laxity, characterized by a rounded appearance of the lateral canthus and therefore the ability to tug the lower lid medially quite 2 mm.
• Medial canthal tendon laxity, demonstrated by pulling the lower lid laterally and observing the position of the inferior punctum. If the lid is normal the punctum shouldn't be displaced quite 1–2 mm. If laxity is mild the punctum reaches the limbus, and if severe it's going to reach the pupil.
Treatment
The approach to repair depends on apparent causation and thepredominant location of the ectropion.
• Generalized ectropion is treated with repair of horizontal lid laxity. this is often achieved with a lateral tarsal strip procedure, during which the lower canthal tendon is tightened by shortening and reattachment to the lateral orbital rim; this isparticularly helpful if the lateral canthus is rounded and lax, with associated tear overflow. Excision of a tarsoconjunctival pentagon is an alternate which will be placed to excise a neighborhood of misdirected lashes or keratinized conjunctiva.
Medial ectropion, if mild, could also be treated with a medialconjunctival diamond excision (medial spindle procedure), though must often be combined with a tarsal strip or lateral canthal sling (see ‘Treatment’), or pentagon excision as significant horizontal laxity frequently co-exists.
• Medial canthal tendon laxity, if marked, requires stabilization before horizontal shortening to avoid excessive dragging of the punctum laterally
. • Punctal ectropionwithout more extensive lid involvement.
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